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NPI Code Detail

MEDICARE: JOHN M SCHUDERER LISAC LPC

MEDICARE: JOHN M SCHUDERER LISAC LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLISAC11381AZ
2101YP2500XProfessional CounselorLPC10607AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174584957
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN M SCHUDERER LISAC LPC
Provider Business Mailing Address
First Line : 642 DAMERON DR
Second Line :
City : PRESCOTT
State : AZ
Zip : 86301-2411
Country : US
Telephone Number : 928-445-5211
Fax Number : 928-776-8484
Provider Business Practice Location Address
First Line : 642 DAMERON DR
Second Line : WEST YAVAPAI GUIDANCE CLINIC INC HILLSIDE CD
City : PRESCOTT
State : AZ
Zip : 86301-2411
Country : US
Telephone Number : 928-445-5211
Fax Number : 928-776-8484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 09/11/2025

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